Mrs. Resnick Case Analysis Case summary/formulation

 

 

 

Mrs. Resnick Case Analysis

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Mrs. Resnick Case Analysis

Case summary/formulation

Mrs. Resnick complains that her heart beats fast and pounds like it is going to burst. She feels tightness in her chest and cannot catch her breath. She also complains of whole-body body aches, joint, and muscle trouble. Her symptoms started two months ago and have been progressive. She tenses for no reason at work and home. She cannot stay still and finds it difficult to concentrate at work. She worries constantly that her husband and children might get hurt i.e get involved in a road accident. She also worries that she might make poor decisions at work. She finds it difficult to control her worry. She has normal sleep and appetite. Going out with her husband and eating help calm. She even sometimes have fun when she goes for evening walks with William, her husband. She spends her free time reading, going to church, and singing in the choir. She cannot read much when she is alone. During the interview, Mrs. Resnick was anxious, talked rapidly and shifted uncomfortably in her chair, and got angry on one occasion.

DSM-5 diagnosis and differentials

Generalized anxiety disorder is Mrs. Rasnick’s most likely DSM-5 possible diagnosis because excessive anxiety and worry, associated somatic symptoms, and impaired occupational impairment are her predominant symptoms. Besides, she has no control over her worry. However, her symptoms have not lasted for more than six months and the diagnosis for GAD can only serve as a provisional diagnosis (American Psychiatric Association, 2013) .

Separation anxiety disorder is a differential diagnosis because Mrs. Resnick does not like being away from her husband and children because she fears they might be involved in road accidents. However, this differential can be excluded because her worry does not revolve around the theme of separation and has lasted less than six months.

Organic conditions such as pheochromocytoma and thyroid disease should be considered in this case. thyroid hormones increase the sensitivity of β adrenergic receptors in the heart and α-adrenergic receptors in blood vessels. Excess epinephrine is secreted in pheochromocytoma. The increased secretion of epinephrine and increased sensitivity in the receptors results in symptoms similar to anxiety (Sadock et al., 2017). Drug/substance-induced anxiety disorders should also be considered in this case. Alcohol withdrawal and stimulant intoxication are some possible causes of anxiety-like symptoms (American Psychiatric Association, 2013)

Mrs. Resnick finds it difficult to stay still (psychomotor agitation), concentrate at work, and got angry (irritable). Her symptoms have lasted for more than 2 weeks. These are some of the symptoms of major depressive disorder. However, the major depressive disorder can be excluded because neither depressed mood nor loss of interest in pleasure is her predominant symptoms (American Psychiatric Association, 2013).  

Psychopathology of diagnosis with Rationale

Anxiety and worry are copping strategies against harmful emotional experiences. Generalized anxiety disorder results from an exaggerated fear response, cognitive avoidance, impaired extinction learning or retention, and exaggerated anxiety sensitivity. This maladaptive fear response results in excessive activation of neural circuits responsible for fear and anxiety responses. In normal anxiety and fear responses, the amygdala plays a crucial role in developing conditioned fear associations and organizing fear responses. However, In GAD there is dysfunction in amygdala responses. This results in the activation of the stress response axis such as the hypothalamic-pituitary-adrenal axis ultimately resulting in cortisol production. Sympathetic nervous activation also occurs in response to stress. The activation of the sympathetic nervous system results in increased secretion of noradrenaline that mediates some somatic symptoms of anxiety such as tachycardia and motor tension. Dysregulated serotonergic, gamma-aminobutyric, tachykinins and substance P are also implicated in the psychopathology of GAD (Sadock et al., 2017).

Pertinent Risk Assessment with Rationale

Generalized anxiety disorder (GAD) has the greatest risk of suicide ideation, suicide attempts, and completed suicides compared to other anxiety disorders. The prevalence of suicide ideation, a suicide plan, and suicide attempts in individuals diagnosed with GAD range from 10-50%, 26%, and 15%, respecti